NASH E. B, Leaders in Respiratory Organs (nh6) NASH Eugene BeauharnaisPreface The object of this unpretentious work is to place before the busy practitioner the indications, especially the leading ones, in a different way from that usually found in the ordinary text books. To the beginner, arranging the remedies in alphabetical order, without regard to the different stages of diseases, is rather confusing. It may justly be claimed that this way of mine has a tendency to lead to routinism. I have tried to guard against that by repeatedly assuring my readers that any remedy might be indicated in any stage of a complaint, and if so they must not be ignored. As will be seen, I have purposely avoided taking up time and space with the pathology and diagnosis of disease as found in the text books, my reason being that, important as that may be, after all the selection of the remedy, according to our art, according to symptomological indications, is of far more importance for curtive purposes. By this method of symptom-covering we are enabled to cure many a disease which cannot with certainty be named, and about which the best diagnosticians living would widely differ. I hope I will not be misunderstood, and be thought to place too low an estimate upon diagnosis and pathology, but rather as one who has tested the value of Similia Similibus Curantur from the standpoint of Hahnemanns clear teachings and is willing still to stand for it. On account of a busy practice, college duties, etc., I have not been able to do so much as I could wish along this line. But my books so far have received so warm a welcome at home and abroad that I hope that this one more may be considered favorably, and not a perpetration. I have had valuable help in the preparation of the condensed repertory at the end of the work, who modestly prefer not to have their names mentioned. Dr. E.B. Nash Port Dickinson, N.Y. PUBLISHERS NOTE In this book Dr. Nash has discussed specific respiratory conditions individually. The indications for various drugs are clearly stated. A detailed repertory takes up cough, Expectoration, Respiration and the Chest. The book is a splendid consultant on respiratory diseases, inasmuch as it deals with the selection of the proper remedy according to symptomological indications. PAGE 1 Therapeutics Catarrh Acute nasal catarrh (a) Causes An acute coryza or Rhinitis may be an initial symptoms of in infection like influenza or measles; more commonly it s primary a cold in the head. Its epidemic and contagious character is so marked that it probably depends upon germ infection. The chief predisposing causes are exposure to cold, variable weather and inhalation of irritating vapors. (b) Symptoms There is chilliness, headache, slight fever (100 to 101) and sneezing, with quickened pulse, dry skin and throat. Some backache and general aching are not uncommon. The nasal mucous membrane swells, so that mouth-breathing is imperative, and there is a thin acrid discharge from the nostrils. The yes water, the senses of taste and smell are impaired, the pharynx is reddened, the throat is sore and the neck stiff, and slight dysphagia may be present. Herpes of the nose and lips is common. The larynx may be involved, causing hoarseness; the trachea and bronchi, cough; the Eustachian tubes, slight deafness. In a day or two the nasal discharge increases, becomes thicker and muco-purulent, and in 5 or 6 days the swelling of the mucosa and associated symptoms subside. The coryzal discharge persists for a week or two longer. (c) Diagnosis Ordinarily easy, but the possibility that it is the initial coryza of measles or influenza is to be borne in mind. (Butler.) This is perhaps as good a condensed description of Acute Nasal Catarrh as could be given, but the question as to the possibility or probability of germ infection ought to be settled, in order to enable the proper hound (germicide) to be et on the track of the germ. Another thing deserves passing notice before we enter into the therapeutics of this affection, i.e. , the discharge is not always acrid as Butler states. It may be acrid or bland. It may be acrid from the nose and non-irritating from the eyes or vice versa. Other finer points necessary to be observed by the homoeopathic prescriber will be mentioned as we go through the indications for the remedies. PAGE 2 Therapeutics If the primary cause is the cold in the head from exposure simply, and not of the epidemic variety, it is important to know what kind of exposure it was. Aconite. Is adapted to such suffering from exposure to dry cold air. Chill or coldness followed by fever heat and restlessness, headache at the root of the nose, not much coryza as yet; or habitual coryza suppressed; burning and pricking in the throat and Eustachian tubes are symptoms commonly found indicating this remedy. If given early in frequent doses for an hour or two the fever will abate and be followed by perspiration and general relief of all the symptoms. There is another remedy not so often used as it ought to be, and it comes before the reaction from the chilly stage has occurred, which calls for Aconite viz. : Camphor. Icy cold; cold subjectively and objectively. The blood seems to have receded from the surface, especially the extremities. It is like the collapse of cholera. The nose is stopped, dry and pointed. The head aches in the frontal sinuses, even throbs. PAGE 3 Now seat yourself by the fire, and take a drop on sugar, every five minutes, of common spirits of Camphor until reaction sets in, and there is an end of that cold. It is especially efficacious after a ride in the cold air, until thoroughly chilled through, even prostrated by the cold. Anyone who understands the principles of Homoeopathy can see how Camphor is here the remedy. But it is in the very first stage of a cold that it is to be used. After reaction sets in, Aconite or some other remedy will be indicated. Nux Vomica is another splendid remedy for the first stage of a cold. The nose is stopped, or stops at night and runs through the day; There is frontal headache. Throat sore and very sensitive to inhaled cold air. But the most characteristic indication is that the patient is chilly on the least motion or uncovering. Even during the fever, must be covered and keep quiet. These three remedies, according to indications as above, will often serve to check a cold and prevent the fluent coryza, or fluent stage which will follow in the general course of the disease, if left to itself. Bryonia may follow Aconite or Nux vom., if notwithstanding these remedies the nose remains dry and obstructed, and the headache over the root of the nose persists and is greatly aggravated on motion. The lips are parched and dry, and there is much thirst. If the first stage is passed and the fluent coryza has set in another class of remedies comes in, such as Mercurius. With this remedy there are creeping chills; worse in the evening and night, even in bed. The nose discharges thin water with sneezing and lachrymation and sore throat, which stings and pricks, with a constant inclination to swallow saliva which accumulates in abundance, accompanied with a bad smell from the mouth. There may be fever and later on profuse sweat, which however does not relieve. PAGE 4 Allium cepa may dispute place with Mercurius, so far as fluent coryza and lachrymation are concerned. The discharge from the nose is profuse, watery and corrosive. It corrodes the nose and upper lip, and is worse in the evening and indoors, and better in open air. It has also profuse lachrymation, with burning, biting and smarting in the eyes, but the discharge unlike that from the nose is bland. It does not excoriate the cheeks as does the nasal discharge the nose and upper lip (Euphrasia is exactly the reverse, i.e. , corrosive lachrymation and bland nasal discharge). There may be headache and that is also worse in warm room and better in open air; This remedy is particularly useful in children, when the profuse coryza or cold extends downward to the bronchi, wit a like profuse secretion in the tubes, with cough and much rattling of mucus. Arsenicum follows well either of these three remedies (Merc., Euph. and Cepa) in fluent coryza, when neither of them seem sufficient, but discharge becomes more burning in character. The throat also burns but is relieved by hot drinks so long as they are running over the part. The chill and heat alternate or intermingle. There is generally amelioration from heat of room, or hot local applications. There is also greater weakness and prostration than with the other remedies and the whole case is aggravated at night; especially at midnight. Four more remedies that might be used oftener than they are Sabadilla, Arum tri., Sang. nit. and Kali iod. Sabadilla. Has profuse sneezing and lachrymation which is decidedly aggravated in open air and bright light. There is often sore throat running from left to right like Lachesis, but unlike it, there is desire for hot drinks, which ameliorate. There is also a sensation as of a lump in the throat which creates constant necessity to swallow. PAGE 5 It is especially useful in hay-fever or hay-fever subjects. Every time he takes cold it settles in his nose and throat. Aurum triphyllum is an excessive irritant to the nose, mouth and throat. The discharge is ichorous, and the surfaces raw red and sometimes bloody, with a sensation which causes the patient to bore with his fingers into the sensitive and raw surfaces. There is also sore throat and hoarseness with continually changing or breaking voice. Sanguinaria nitrate irritates intensely the nose, eyes, throat and bronchi. The throat is dry and burns, as does also the nose. This sensation of rawness and burning extends all through the nose, posterior nares and throat. The third and sixth trituration of this remedy dry on the tongue once in two or three hours will sometimes check the progress of such a cold and prevent its running through all its stages. Further use of the remedy will serve to draw out more positive characteristics so that it can be used higher. Kali iodatum. Redness and swelling of the nose, with constant discharge of watery, acrid, colorless liquid. Oedematous swelling of the eyelids with lachrymation. It is especially to be used after Mercury has done all it can, or fails; and more especially in syphilitic subjects who have been abused by Mercury. Such subjects are liable to repeated violent attacks of acrid coryza with bloated eyelids. The above remedies are, according to indications, able to cure ordinary colds or coryzas and the consequences of them, if skill fully applied. PAGE 6 If after these two stages are passed anything more is needed we have. Pulsatilla, which is generally the best remedy if there is that bland discharge from the nose, or the same kind of expectoration with the cough. The sense of smell is blunted or lost, also taste, or bitter taste. There is no thirst, and generally poor appetite. The choice may lie between this remedy and Mercurius solubilis, but Mercurius is weak and sweats easily, or at night in bed, and the mouth is moist, with bad smell, flabby tongue with indented edges, and thirst. Sulphur follows well either of these two remedies, especially in psoric constitutions, and will often finish up the case and prevent its running into the chronic form. We said, of the diagnosis of this disease, that it was ordinarily easy, but the possibility that it is the initial coryza of measles or influenza is to be borne in mind. If it is measles we will bear in mind such remedies as Aconite, Gelsemium, Euphrasia, and Pulsatilla. That does not come within the scope of this work. But. Influenza or, as it is now popularly known, La Grippe we will have to notice. What distinguishes influenza (which is really nothing more than a violent catarrhal fever) from other fevers of this class is the circumstance, that influenza attacks the whole nervous system at once. Sometimes with rheumatic pains in the limbs. More or less lameness, fever and inflammatory symptoms which may increase to a genuine acute bronchitis or pleuritis. This disease which for a few years seemed to be modified in intensity from what it was when it first broke out in Europe (fifty years ago) has seemed to revive its former severity in the last ten or fifteen years, so that many cases are utterly prostrated by it, and long lasting effects follow. PAGE 7 One of the best and oftenest indicated remedies is the one discovered by accident when this malady was at its beginning so severe and general, and the symptoms so uniform that it was dubbed break-bone-fever, and the remedy, on account of its efficacy called bone-set, is Eupatorium perfoliatum. Deep seated, aching all over as if in the bones, especially severe in the back, wrists and ankles. There is also severe bruised soreness (Arnica) so that the patient is worse on motion (Byron.) although he feels very restless (Rhus), even to the muscles of the eyes as expressed in the symptom eyeballs sore on turning them, watery coryza often present, but may be absent, also nausea, or vomiting and prostration. The choice often lies between this remedy, in the first stage of the disease, and Gelsemium; With this remedy the general prostration is very marked; wants to lie perfectly still, and trembles from weakness with the least exertion; even the hands tremble when lifting them up; the eyelids droop from weakness. It seems almost a semi-paralytic state. There is fever, but little or no thirst, the tongue trembles when protruding it. The sensorium is in accord with the general weakness; blunted, but little or no delirium. Bryonia alba stands about midway between Eupatorium and Gelsemium. Like them it is better when quiet and greatly aggravated on motion, the face turns pale on rising and he faints or is nauseated, and stitching pain in various parts are prominent. It must come early into the case if there are the stitching pains in the pleura. All three remedies have aching pains, but Eupatorium is bone pains. Gelsemium muscular or myalgia. Bryonia intermixed with stitching pains. One or the other of these three remedies will, in the majority of cases, according to my observation, control the case, or so modify it as to make the subsequent treatment easy. But if they should not, such remedies as Causticum. rhus tox. Arsenicum, Sulphur, etc., will be necessary to finish the case. Either one of the above described forms of catarrhal inflammation, may, on account of complications, or of our being called in too late to apply our treatment in time, run into laryngitis, bronchitis, pneumonia, etc. Then we will be obliged to treat them according to our art, as will be described when treating these affections. But without involving these organs to any great degree, we may have following as the results of recurring attacks of the acute form : PAGE 8 Chronic nasal catarrh It may also be caused by syphilis and tuberculosis. It may appear in three forms. Simple Chronic Catarrh - in which the mucous membrane becomes congested and swollen, sometimes to the degree of stenosis. It may be dry or with an abundant thick secretion. All this may occur repeatedly on catching cold, to which the patient is very liable. If this persists the lower turbinals are swollen and enlarged, there is constant hawking to remove the thick secretion from the upper pharynx, and the patient becomes a mouth-breather to a varying extent. In the majority of cases the pharyngeal mucosa and adenoid tissues are coincidentally affected, constituting a chronic naso-pharyngeal catarrh. The voice becomes nasal, and varying degrees of deafness are common. Post-nasal dropping is also common. It is then called Hypertrophic Rhinitis. Another form of chronic catarrh, called Atrophic Rhinitis, may be, but is by no means necessarily, a sequence of the hypertrophic form. The horrible and disgusting odor (ozaena) which is the principal symptom of the disease, is met with also as an evidence of syphilis, diseases of the nasal bones, glanders, and foreign bodies. The sense of smell is abolished. On inspection, the nasal mucosa is seen to be shrunken and atrophied, with a resultant unusual roominess of the nasal chambers. This thick purulent secretion coating the membrane, dries into yellowish-green adherent crusts, which emit the offensive odor. PAGE 9 So far as this classification is concerned, it is not possible to draw a line of demarcation so distinct that it would invariably indicated where recurrent acute catarrh left off and the chronic form began; and so far as the treatment is concerned, the symptoms would have to decide the choice of remedies whether the disease be one of the recurrent acute form or the chronic form flaming up so as to simulate it. PAGE 10 Lycopodium is one of the best remedies if the catarrh is of the dry form; stoppage of the nose at night, so that the patient has to breathe through the mouth. If given not lower than the 30th and not too frequently and at too short intervals, it will cure many cases and prevent adenoids, or remove by curing them. Of course the other Lycopodium symptoms and constitution will, in greater or less degree, be found present. Hepar sulphur. If the patients nose stuffs up tight on any exposure to the cold air; and is extremely sensitive to cold air, which brings on the catarrh, croup or cough. It is especially useful in cases that have taken Mercury in large doses. Sticta pulmonaria is not only useful in acute colds, where there is severe pain in the forehead and root of the nose before the discharge sets in, but in the chronic form it is just as good. The nose is stuffed up with the same present and fullness in the root of the nose, and frontal sinuses, and the nasal secretion dries up and sticks, causing a constant desire to blow the nose or forms into scabs difficult to dislodge. In some cases mucus drops from the posterior nares, and the throat looks raw and feels like dried leather. Sometimes the choice will lie between this remedy and Kali bichromicum, which also has many scabs or clinkers, and similar pains over the root of the nose, especially when the discharge becomes suppressed by cold or other causes. It also has a post nasal discharge, and it is apt to be tough and ropy like all the mucus discharges of this remedy. Then again Kali bich. takes a deeper hold upon the tissues than Sticta. The nostrils fill with dry hard crusts, that are often bloody when discharged. The septum ulcerates or round ulcers penetrate, or sometimes entirely destroy it. This state of things may occur with or without a syphilitic element in the case. In syphilitic cases of course there is offensive smell attending such deep seated disorganizations. In syphilitic ozaena PAGE 11 Kali iodatum may be preferable, especially in those cases that have been abused by Mercury. In such cases we may have repeated attacks of apparently acute coryza, but otherwise there may be accumulations of very tenacious mucus in the nostrils, or discharges of greenish black, or yellow matter smelling foul, or like the Kali bich. may have ulcerations, but they involve the frontal sinuses and antrum rather than the septum. The remedy that forms a valuable trio with Kali bich. and iod. is Aurum; in the form of the metal or muriate. It eats more deeply than either of them, involving the bones of the nose. Leading Symptoms Crusts in the nose; obstructed, ulcerated, agglutinated, painful nostrils, ozaena; thick fetid discharge, severe frontal headache, caries. The patient is melancholy even to suicide. Like the Kalis it is especially useful in cases that have been abused by Mercury or Kali iod. or both. Two remedies that occur to me with the last three, and which perhaps ought to have preceded them here, as they generally do in the course of a chronic catarrh, are Pulsatilla and Kali sulphuricum. The former is first to be considered in a chronic catarrh, which has followed one or several acute attacks. The thin watery discharge of the first stage has changed to thick green, bland, sometimes offensive with loss of taste and smell. The nasal mucus becomes offensive as of old catarrh, it is worse in the evening and in a warm room, as is the patient generally, or, in other words, it is better in the open air. The- PAGE 12 Kali sulphuricum is so like Pulsatilla that it deserves the name of its chronic, and if Pulsatilla does not cure such a case, and it tends to get worse instead of better, Kali sul. will complement it very nicely. This is so, not only in catarrh of the nose, but also where the process continues downward to bronchi and lungs. It is especially useful where there is much rattling of mucus remaining. Of course Sulphur and Calcarea ostrearum will never be forgotten in chronic diseases of any kind. Both have the chronic form of catarrh, with thick, fetid, purulent discharge of offensive smell, etc. Sulphur suiting the psoric constitution and temperament, and Calcarea the leucophlegmatic. Indeed the choice of such remedies will often rest on general indications rather than the local. In fact, these must also enter into all prescriptions of any remedy, no matter how strong the local indications. the whole patient must be considered. Our list of remedies might be extended to much greater length, and indeed the whole materia medica or any of the remedies so far mentioned or not mentioned may be called into requisition in all forms of nasal catarrh. And here again we desire to emphasize, lest we be misunderstood, that we, as homoeopaths do not treat local manifestations to the exclusion of the other abnormal symptoms which characterize the sickness of the patient. But some remedies do act by preference on certain localities and organs, and when the so-called disease manifests the same kind of preference, or centers its force in such localities, the remedy having both the general and local manifestations in its pathogenesis is the one to use. PAGE 13 We will now mention in alphabetical order some more remedies with indications that have been found reliable when coupled with the general indications which must correspond. AEsculus hippocastanum. Fluent coryza, dull frontal headache, thin, watery discharge, burning, rawness, sensitive to inhaled air (Nux v.). Ailanthus glandulosa. Copious, thin, ichorous and bloody discharge from the nose (Scarlatina). Ammonium carbonicum. Nose stopped at night; mouth breathing. Asafoetida. Discharge of very offensive matter from the nose; with caries of the bone. Corallium rubrum. Profuse secretion of mucus dropping into posterior nares, obliging frequent hawking; inspired air feels cold. Dulcamara. Dry coryza, stoppage of nose, or coryza suppressed, or agg. from least exposure to damp cold air. Graphites. Chronic nasal catarrh; internal nose dry, with dry scabs with sore, cracked and crusty nostrils (Ant. crud.). Sore on blowing it. Hydrastis Can. Stuffiness of nares, discharge of thick, yellow and stringy mucus, or dropping down into posterior nares. So profuse as to be raised in long tenacious strings (Kali bich.) Ozaena with purulent, bloody discharge). Kali mur. Catarrh extending to the Eustachian tubes Lachesis. Complaints from suppressed catarrh; amel. by the restoration of discharge. Natrum muriaticum. Acute coryza with clear, profuse, watery, white discharge, like in hay fever; or chronic catarrh with sore wings and scabs in the nose. PAGE 14 Natrum sulphuricum. Chronic catarrh, both ante and post nasal, discharge yellow or green, agg. in damp weather. Nitricum acidum. Discharge acrid, watery, offensive, corroding upper lip in scarlatina, diphtheria or syphilis; or cracks, or ulcerations of nostrils, scurfy, bloody matter, with pricking as from splinters in the nose. Petroleum. Ozaena, scabs and purulent mucus, nose sore, nostrils cracked, extending to Eustachian tube. Phosphorus. Frequent blowing of blood from the nose; handkerchief is always bloody, chronic catarrh. Psorinum. Is, like Sulphur, always to be carefully considered in psoric subjects. This is like Hepar, Sulphur, Silicea and Tuberculinum, very susceptible to cold air or change of weather; wants to wear a fur cap, overcoat or shawl even in the hottest weather. It is also especially useful in chronic catarrh with purulent or bloody discharge which may be yellowish-green, like the expectoration. It is dropping from posterior nares so as to awaken at night. Hawking of lumpy mucus gives temporary relief. Sambucus. Nose stopped up tight, especially in children snuffles. Sepia. Dry coryza, nostrils sore, ulcerated, scabby, discharge large, green, offensive smelling plugs. Silicea. Chronic coryza, ulcers high up in the nose, fetid, offensive discharges, caries of bones, from syphilis or scrofula. Amel. from having head wrapped up warm. Thuja occidentalis. Much thick, green mucus with blood and pus; brown scabs form, which are painful, sycotic diathesis. Tuberculinum must not be forgotten when the patient is continually taking cold, says the least exposure brings on a new cold. This is especially to be regarded if the patient has a tuberculous history. It is often the beginning of consumption, and may be checked by this remedy, if given high and at not too frequent intervals. PAGE 15 Repertory to nasal symptoms We will conclude this part of our subject by giving a few remedies in a sort of repertorial form, as leaders to a fuller study of them. I have purposely not allowed more than seven to come under one list, because it would not be advisable to do so. I have also meant to arrange them as far as I could in the order of their importance. Dry coryza (no discharge) Nux vomica, Sticta, Lycopodium, Camphor, Ammonium carb., Sambucus, Bryonia. Nostrils obstructed Nux vomica, Sticta, Ammonium carb., Lycopodium, Kali bichromicum, Pulsatilla, Sambucus. Coryza fluent, or thin, watery discharge Allium cepa, Mercurius, Arsenicum, Sabadilla, Euphrasia, Kali iodatum, Sanguinaria nitrate. Discharge corrosive or excoriating Allium cepa, Arsenicum, Arum triphyl., Nitric acid, Bromium, Sanguinaria nit. Discharge bland Pulsatilla, Euphrasia, Kali sulph. discharge green Pulsatilla, Mercurius, Sepia, Kali iodatum. discharge yellow Pulsatilla, Kali sulph., Kali bichrom., Sepia, Sulphur, Lycopodium, Aurum. Crusts and scabs Sticta, Kali bichrom., Sepia, Thuja, Natrum arsenicatum, Aurum. Offensive Aurum, Asafoetida, Pulsatilla, Mercurius, Hepar sulph. PAGE 16 Purulent Mercurius, Hepar sulph., Aurum, Kali bichrom., Silicea. Stringy discharge Kali bichrom., Hydrastis, Sanicula. discharge from posterior nares Corallium, Mercurius protoiod., Ferrum, Cinnabaris, Hydrastis, Natrum carb., Natrum mur., Psorinum. Hay fever Sabadilla, Allium cepa, Gelsemium, Lachesis, Sinapis nig., and Mountain air; worse in the morning, Nux vomica; agg. in the evening, Allium cepa. Ozaena Aurum, Kali bichrom., Mercurius, Pulsatilla, Sepia, Silicea, Hepar sulph. Pains in the bones of the nose Aurum, Kali bichrom., Kali iod. Worse at night Mercurius, Aurum. Pressing at the root Sticta, Kali bichrom., Mercurius biniod., Pulsatilla. Sensation of rawness AEsculus, Arum triphyl., Mercurius corr., Kali iodatum. soreness inside Arum triphyl., AEsculus, Kali bichrom., Nitric acid., Silicea, Aurum. Smell lost Pulsatilla, Hepar sulph., Mercurius. Sneezing Allium cepa, Mercurius, Sabadilla, Arsenicum, Cyclamen, Carbo vegetabilis. Snuffles Nux vomica, Sambucus, Lycopodium. Ulcers inside Kali bichrom., Aurum, Nitric acid, Sepia, Silicea, Thuja. PAGE 17 Laryngitis Butler (Diagnostics) classifies this as follows : Acute Catarrhal Laryngitis. Acute Laryngitis with spasm of the glottis (croup). Chronic Laryngitis. Oedema of the Larynx. Tuberculous Laryngitis. Syphilitic Laryngitis. Tumors of Larynx. Laryngismus stridulus and paralysis of the Larynx. It is not the object in this work to write out the diagnosis of each of these forms of Laryngeal trouble, for that may be found in the many good works already written, such as Butler, Bartlett and others. We have to do with the leading indications of the remedies found most useful in the treatment of them. In fact, after the diagnosis is clearly made the symptoms which correspond between the patient and the pathogenesis of the remedy will have to guide to the choice. This is true whether the case be one coming from colds or other causes of acute Laryngitis or whether it e one originating in, or being complicated by, Syphilis, Psora, Sycosis, Tuberculosis, etc. It is lamentably true that many diseases are caused or aggravated by the misuse of drugs, and this, too, must be taken into the account. A remedy may be indicated in several forms, both acute or chronic, as, for instance, Bichromate of Potash or Hepar sulphur, so in giving our leaders we will feel free, or not, to mention varieties, etc. PAGE 18 Not giving the remedies in alphabetical order, as is done in most works, we may well begin this list with Aconite, as it has a decided and positive action on the larynx. Aconite is often indicated in the acute form, brought on by exposure to cold dry air, most works say cold west winds, and that depends on whether you are living on the Atlantic shores or the Pacific. Cold dry air is better; chill or chilliness, followed with fever, with hot, dry skin, great restlessness, impatience and fearful anxiety. The child wakes up in the night with croupy cough and breathing; pain in the larynx and anxious suffocation. With this remedy most cases can, if taken early, be cured in a short time or so modified that other remedies easily finish up the case. This is of course in cases uncomplicated with specific Miasms. Belladonna may follow, or be preferable at the first, if in head of the fearfulness and anxiety there should be just as high or even higher temperature, the skin seeming fairly to radiate heat, or impart a burning feeling to the hand that touches it; there is drowsiness with twitching; spasmodic or barking cough, pain in the larynx, dark red, turgid face, throbbing carotids; dilated or contracted pupils; sweat on covered parts (Acon. dry), all the disease or vascular excitement tending to the head. Delirium is common with this remedy, and it is especially indicated if there is dry soreness of the throat. Arum triphyllum. In acute or chronic forms of the disease where there s hoarseness or rawness (Caust.) of the throat; cant control the voice, breaks when trying to talk or sing; dry cough at first, later with expectoration or accumulation of mucus. Especially useful for opera singers or public speakers who lose their voice (Rhus tox.). Allium cepa. Violent catarrhal laryngitis, especially if accompanied or preceded by the characteristic coryza of this remedy, pain in larynx when coughing, causing the patient to grasp the larynx when coughing, agg. on inspiring cool air and in the evening. PAGE 19 Causticum. Acute or chronic when there is sense of rawness or soreness in throat larynx, sometimes extending down the trachea with soreness on coughing even through the whole chest. There may be partial or complete loss of voice; the hoarseness is generally agg. in the morning (Carbo veg. evening). Sometimes involuntary escape of urine with the cough. Drosera. Hoarseness with very deep bass voice. Much cough especially after midnight; especially if it becomes spasmodic like whooping cough. The cough, also like the voice, has a deep trumpet tone, something like that of Verbascum, but the later goes lower down than the larynx. Hepar sul. Croupy cough agg. in the morning. The patient is very sensitive to dry cold winds, which bring on repeated attacks, and the cough is aggravated even if exposure of the body or a hand to cold air takes place. Generally there is rattling of loose mucus, but little is expectorated. Even asthmatic wheezing may be present. Hepar is a valuable remedy in both the acute and chronic form of the disease. Apis. If Belladonna fails where there is much redness, stinging or an oedematous condition of the throat, or sub-mucous tissue of the larynx, suffocative cough and dyspnoea, feels as though every breath would be the last, agg. by lying down and warmth. Of course this is mostly in the acute form of the disease. Phosphorus. Hoarseness; lining of vocal cords highly injected, cough agg. by talking, laughing, singing, cold air or lying on left side; tickling in the larynx and spasmodic cough, followed by dryness and burning in the throat. PAGE 20 Spongia. Acute form with burning and tickling in the larynx; swelling of larynx with sensation of a plug in the throat; great hoarseness with sawing respiration, especially in threatened laryngeal phthisis. Iodine. Especially in brunettes, with constant tickling cough with pain in the larynx, ulceration, great emaciation and hunger. Glandular swelling or dwindling. The general symptoms will guide to its choice better than the local. Kali bich. The expectoration of stringy mucus is the chief indication. It draws out in long strings hanging down to the floor. The cough is agg. mornings and often nearly strangles him. Calcarea ost. is useful in the chronic form. The patient is very hoarse, sometimes can only speak in a whisper; also roughness or sense of rawness in the larynx, all agg. in the morning. Expectoration also in the morning and during the day, little or none at night, though the cough may be worse. The general symptoms of the remedy are present in abundance, and it is especially useful in the well known Calcarea ost. temperament. Carbo vegetabilis is also well adapted to the chronic form, though it may come in early and prevent it, if there is hoarseness equal to Calcarea or Causticum, but is agg. in the evening or the damp air of evening. It is particularly well adapted to old or elderly people of low or reduced vitality. With both Calcarea and Carbo veg. there may be thick heavy expectoration. Argentum met. is useful in hoarseness of professional singers. loss of voice at times, always agg. by speaking or singing. The cricoid cartilage is painful, painful to touch with sensation of foreign body; over the bifurcation of trachea a raw spot, and coughs up a gelatinous phlegm. PAGE 21 These fifteen remedies are leading ones for the treatment of affections of the larynx, but not by any means all of them. For instance, Aurum, Mercury, Kali iod. might, and must, come into consideration for syphilitic cases, as must Sulphur and the other antipsorics in psoric complications and causes. So far as local treatment of this affection is concerned, the specialist may come in for his share of the work; but even here an understanding of the homoeopathic therapeutics will enable him to do infinitely better work than his allopathic neighbor who depends almost altogether on local measures. These local affections are almost always caused or complicated by constitutional states, and to ignore this is to miss the main chance for the best and most lasting benefit. Too many of our own men are drifting away from our superior therapeutics t the local treatment side of these affections. The inevitable result of this is to cripple them, do injustice to those who have a right to expect better things of them than from the allopaths, and dishonor the name which they bear as subscribers to the doctrines of Hahnemann. The only advantage to arise from these departures is that they will not cure their patient, but by deceiving them with palliations instead, may expect them back again and again for a repetition of the same treatment. Of course, there is money in that. If any man will practice medicine, either general or special with the idea of money making as his chief object, it seems to me that he is not entitled to the respect of God, man or the devil. It is to be hoped that there are few such on earth, and therell never be one in heaven. PAGE 22 One other thing I wish to mention in closing; local treatment alone is oftener merely suppression rather than cure, and this being the case the affection is very apt to locate where it cannot be reached by local measure, as, for instance, in the bronchi, lungs or elsewhere, and the last state of that man is worse than the first. This is a most important truth and should not be ignored. PAGE 23 Croup As to the unanimity of the old school authorities in regard to this disease we may judge something by the following : Membranous croup is in the large majority of cases laryngeal diphtheria; in a small minority (italics ours) streptococcus inflammation. It is usually secondary by extension from the pharynx, occasionally primary. A croupy cough, hoarseness or aphonia, and above all the evidences of progressive laryngeal stenosis, constitute the leading symptoms. As the narrowing of the glottic opening proceeds, the breathing becomes stridulous and dyspnoea and cyanosis become manifest. The supra-clavicular, episternal, intercostal, and epigastric spaces are deeply retracted with inspiration and bulge with expiration. The child is excessively restless, the nostrils are worked violently, and the sterno-mastoids become prominent during inspiration. Shreds of membrane may be coughed up. If the stenosis is not relieved the child passes into a semi-comatose state and finally dies. The fever is usually slight and the general condition of the patient good. The membrane may extend into the trachea and the bronchial tubes. (Butler.) Laryngeal diphtheria. Membranous croup. With a very large proportion of all the cases of cases of membranous laryngitis the Klebs-Loeffler bacillus is associated; in a much smaller number other organisms, particularly the streptococcus, are found. Membranous croup then may be said to be either genuine diphtheria or diphtheroid in character. Of 286 cases in which the disease was confined to the larynx or bronchi, in 229 the Klebs-Loeffler bacilli were found. In 57 they were not present, but 17 of these cultures were unsatisfactory. (Park and Beebe.) PAGE 24 The streptococcus cases are more likely to be secondary to other acute diseases. (Hare). It will be noticed by these two authorities that two kinds of croup are recognized, the membranous and spasmodic, and that the presence of Klebs-Loeffler bacillus is not always present in true cases of the disease. Osler recognizes only one form of true croup. The spasmodic form is called false croup. Mackenzie used to claim that the acute catarrhal form and the membranous variety were only different degrees of the same affection. Our own Raue writes (special pathology) : True croup is most readily confounded with Catarrhal Laryngitis or Pseudo-croup; the latter, however, is frequently attended with other catarrhal symptoms, such as sneezing, coryza, etc., and is apt to occur frequently. diphtheria is thought by some writers (Wagner and others) not to be an essentially different affection from croup, and that there is no sharp dividing line between the two. But if we take into consideration that in croup the exudation takes places upon the free surface of the mucous membrane, and in diphtheria also within it, causing necrosis and loss of substance, that diphtheria is contagious while croup is not, and that in many cases of diphtheria a peculiar penetrating smell from the mouth claims at once our attention, we shall hardly find any difficulty in distinguishing between the two, notwithstanding the close similarity of symptoms between them. This last was written before bacteriology took high rank as a means of diagnosis, and I am of the opinion with Rosenbach (see Physician versus Bacteriologist) and others that the presence or absence of the microbe for purposes of diagnosis is not al there is to it. While we would not underestimate the value of bacteriology as a biological science, the importance of the study of the microscopical world, and should be well aware of the surprising biological information, and important methods found in the study of bacteriology, we are convinced that all the clams of the nothing but bacteriologists cannot be allowed. These diagnosticians in absentia need not expect us, who are at the bedside taking into account the whole case, to stand aside upon their ipse dixit. PAGE 25 Again while it is important for several reasons that we should be able, if possible, to say whether a case is diphtheritic or not, it is equally, and, I think, more important to select the simillimum must be used in some stage of both diseases. For instance, Kali bichromicum, Hepar sulph. and the Iodine may be indicated in either croup or diphtheria, according to indications. So in our leading indications for remedies we will cover (or try to) the ground for croup, whether catarrhal or diphtheritic. Aconite will relieve nine-tenths of the cases of catarrhal laryngitis or croup as it occurs in our northern latitudes. It generally occurs as the result of exposure to dry, cold air, attacking the child in the evening or first part of the night with great excitement, high fever, tossing and gasping for breath. A little of the 12th or 30th dilution in water in teaspoonful doses once in ten or fifteen minutes, until the child becomes more quiet, and then at longer intervals until the fever subsides, will be all that is necessary if administered early in the disease. If, however, the cough persists with a rough, croupy sound, as of a saw driven through a pine board, and the stridulous breathing continues between the paroxysms Spongia is apt to be the next remedy. If the cough becomes more rattling, but still croupy, as if the mucus would come up but does not, and the aggravations are in the latter part of the night or morning, and especially if all the symptoms are made worse by cold air striking the patient, Hepar sulphur comes in. These three were Boenninghausens great remedies, and with them he had success never before his time attained. He gave them in the 200th. They are still as useful as then, and must always be, because Homoeopathy is always the same. But there are cases that will not respond to this treatment, which proves that routinism wont do. PAGE 26 Iodine is a wonderful remedy in croup if occurring in dark complexioned, black-eyed children. The child grasps at its throat during the paroxysm, and cries as if in pain; the fever and restlessness are almost equal to Aconite. It follows well after Hepar. Bromine follows well after Spongia, when the aggravation sets n the next evening, is best suited to light haired, light complexioned children; gasps for breath wants to be carried but very quickly, saying run, run; long-drawn-out inhalation, and great prostration. It is especially useful where the trouble seems to start low down in diphtheria. Kali bichromicum is suited to all cases of the common croup or diphtheria, if the membranous deposit is positive, and there is ropy mucus discharged from the mouth and sometimes nose. I have had the pleasure of curing several bad cases of diphtheritic croup with this remedy. Phosphorus is especially useful when the violence of the attack has been broken by some of the foregoing, but there remains a tendency to relapse; the child grows worse again every evening, or the cough goes down in the tubes and lungs. It will often clean up the case, in desperate cases where other remedies have failed in both forms of croup. PAGE 27 Arsenicum may still avail. The child grows excessively restless, weak, and is especially worse at midnight. In one desperate case of this kind, where another child had just died in the family under eclectic treatment, I succeeded in curing. The child coughed up a tube of membrane with the rings of the trachea distinctly impressed on it. This was a case of diphtheritic croup. Ferrum phos. and Kali mur. so highly recommended by tissue remedy admirers. I have not tried because I have succeeded so well with the above, but Belladonna has sometimes served me when in the first or inflammatory or spasmodic stage Aconite failed. Here the Aconite restlessness and fearful agony was displaced by a condition of as great heat, but there was more of a semi-stupor, twitching and jerking and delirium. Many other remedies might be mentioned, and exceptional cases may call for any one of them according to indications, especially in the diphtheritic form. So far as tracheotomy is concerned, good men can be found to favor or disfavor it. I should not, having had such good results from medication, resort to it early, and would perhaps be charged with failure on account of lateness. But on the other hand, I suspect that many operations clam credit where operation was not at all imperative. n these days of Surgo-phobia the tendency is to a neglect of skilful medical treatment. Finally : The proper time to treat croup so far as a cure is concerned is when they dont have it. One eminent allopathic authority says, Appearing, as it does, almost always in children from one to six years old, but sometimes persisting in its occurrence up to puberty, it chiefly depends upon rickets or malnutrition, etc. If we had said it depended upon psora, what then? Psora is as easily defined as rickets. PAGE 28 But all hair splitting aside as to names, the principle so often insisted upon of treat the patient, of our school, must be recognized. It would take too much time and space to name the remedies that might be indicated, but must be exhibited in order to not only cure the attack, but cure the tendency thereto. We will say, however, that that class of remedies having especial influence over psoric, sycotic and syphilitic or phthisical complication should occupy a large place in our attention. PAGE 29 Bronchitis Acute Bronchitis is an inflammation of the bronchial tubes, which is usually confined almost entirely to the mucous membrane lining them. Chronic Bronchitis is the acute form lengthened out, by lack of proper treatment or no treatment at all, and while the cough, expectoration, etc., continue, the intense inflammatory symptoms attending the first stage are greatly lessened or absent. If there is a tubercular history of family or not this chronic variety of the disease may go on to tuberculosis. Either the acute or chronic form may extend downward, implicating the lungs to such a degree that a so-called Broncho-pneumonia may appear. In these days of what Rosenbach calls bacteriophobia, in which certain cocci are insisted on to pronounce a diagnosis, it is hard upon us that we cannot come closer to the mark in this disease, for, as Hare observes, the micro-organisms infecting the bronchial mucosa are the pneumococcus, which is the most common; Friedlanders bacillus the streptococcus pyogenes, and the pyogenic staphylococci. The Klebs-Loeffler bacillus is usually present in the bronchitis, which complicates diphtheria. In some cases of bronchitis additional micro-organisms have been found, such as the Bacillus typhosus, Bacillus coli communis and various forms of fungi. In most instances, however bronchitis is polymicrobic in origin, and it is often impossible to decide what organism is the primary infecting agent. It is not the province of this work to give the description and diagnosis of these respiratory affections, and we only allude to the micro-organisms as above to show that for purposes of homoeopathic prescribing they amount to little if anything. Even if on microscopical examination tubercle bacilli should be found, the same indications for remedies, according to our art, would have to be applied. Yet for purposes of diagnosis (naming the disease) prognosis and hygiene, especially in the latter case (tuberculosis) such investigation is very proper and useful. Now in regard to the leading indications for the remedies, we will divide the subject into two general parts, which will practically cover all. And first. PAGE 30 Acute bronchitis In the first or inflammatory stage we will be apt to find our remedies in a list like. Aconite, Belladonna or Ferrum phos. Aconite. Chills followed by synochal fever, high temperature, quick pulse, general dry heat, dry skin, with great restlessness, fear and agonized tossing about. There is generally short dry cough, even croupy (in children), and such cases are more often apt to occur after exposure to dry cold air. It is best adapted to sanguine, full blooded subjects. If such an attack should occur in a delicate, pale or weakly subject Ferrum phosphoricum would generally do better work. With Ferrum there is not so much of the nervous excitability as with Aconite, but the fever is very great and congestion to the lungs more liable if anything. Belladonna will follow well either of the two in those cases where Aconite has quieted the great excitement, so far as the anxious restlessness is concerned, but the heat still continues, though there is a disposition to sweat on the covered parts. The disease presents more brain symptoms, such as red eyes, flushed face, throbbing carotids and delirium, and especially if the child starts and jumps in sleep. One of these three remedies will often either check the disease in its first stage or so modify it as to call for one of the following : PAGE 31 Bryonia. Still elevated temperature, great thirst, mouth dry and lips parched, short respiration, dry, hard cough, which hurts the head and chest, splitting headache, and all symptoms greatly aggravated on the least motion, wants to lie perfectly still. It is especially indicated if the trouble extends downward, threatening the lungs and pleura. Mercurius. The whole mucous membrane catarrhal, but, unlike Bryonia, there is great thirst with moist mouth, salivation, tongue flabby, showing prints of the teeth upon it, and offensive breath. The fever is still high and there is profuse sweat, which does not relieve. The more the sweat the more the suffering. Chamomilla is especially useful in this stage, especially in children if the heat is accompanied with profuse sweat on the head. The sweat is very hot while that of Mercurius may be cold or clammy. There is great pain and restlessness, child wants to be carried, one cheek red and hot, the other pale and cold. The disposition is ugly, nothing pleases. Now if these remedies have broken the violence of the attack, but convalescence does not set in satisfactorily, there is danger of it assuming the chronic form. Sulphur, may now come in. There is still some fever which comes and goes in flashes of heat, which pass of with a little sweat and debility, there are faint weak spells, and generally, on enquiry will often disclose a psoric taint which is very apt to stand in the way of satisfactorily indicated drugs. A dose of this remedy may clear up the case and secure prompt recovery or pave the way to the more successful employment of other remedies. If the case seems to settle down into a persistent form of the disease we may have to resort to the following remedies : Hepar sulphur, Causticum, Phosphorus, Pulsatilla, Kali sulph., Sanguinaria, Antimon. tart. PAGE 32 Hepar sulphur is indicated when there is a loose, rattling cough, with choking or wheezing breathing. It is not so dry and barking as Spongia, still little is expectorated, and the cough is made decidedly worse by exposure to cold air, even if a hand becomes uncovered. The cough is also generally agg. in the early morning hours. Causticum coughs hard and dry with great soreness from larynx down through trachea into the chest. There is apt to be great hoarseness agg. in the morning, and involuntary escape of urine with the cough. Phosphorus. Larynx so painful he can hardly talk, which aggravates the constant cough. Phosphorus. Larynx so painful he can hardly talk, which aggravates the constant cough. Trembles all over with cough, and it is especially worse in the evening, and lying on the left side. Cough hurts and the patient holds the breath and lets it out with a moan because it hurts him so. There is great tendency to extend into the lungs with sense of oppression of the chest. (See Pneumonia.) Sanguinaria. Coughs hard with circumscribed redness of the cheeks, but its best place is where the disease lingers; a loose cough with offensive expectoration that looks like the patient was running into consumption. Antimonium tartaricum is almost always loose cough with much coarse rattling of mucus, which is so abundant that the patient becomes cyanosed and cannot raise it. This is a serious condition and Antimonium tart. will often help. It is particularly found indicated in children and old people. If, notwithstanding the use of this remedy, the rattling and weakness increase, the cyanosis also, until the blood stagnates in the capillaries, the extremities and breath become cold, and the patient gasps fan me, fan harder, Carbo veg. is still able to turn the scale in favour of the patient. I have witnessed this result more than once. It is in these cases more of a broncho-pneumonia than simple bronchitis. PAGE 33 If so far under the preceding remedies the case has improved until the inflammatory symptoms are mainly gone, but there is still considerable cough with loose rattling of mucus which needs clearing up, there are these two remedies that often will do it. Pulsatilla or Kali sulphuricum. The former, if the expectoration is green and bitter, there is bad in the mouth, the appetite is poor and the patient is very hungry for cold air, wants cool room or open air. If this does not do all, Kali sulph. is its chronic and often follows well on the same indications, of course there are other remedies which may come in according to indication, we cannot tell which one, but the whole materia medica is our armamentarium, and the true homoeopath knows how to draw upon it, and use it. When Bronchitis has settled into the chronic form, there may be acute exacerbations that may at times call for the foregoing line of treatment, but a long list of remedies claims our attention; prominent among them are Sulphur, Calcarea carb. and Lycopodium, which Jahr considers a great trio in the order here mentioned, at long intervals apart. Sanguinaria, Kali hydrod. and Stannum form another trio where the expectoration is profuse. Arsenicum, Ipecac and Natrum sulph. where there are asthmatic complications, will often be very useful. Kali bich., Hydrastis and Coccus cacti, in profuse stringy expectoration. Ammonium carb., Cinchona and Carbo vegetab. are often of use in weakened constitutions, especially in aged people. Hepar sulph., Silicea and Tuberculinum are great in those cases which are profuse and purulent (the expectoration), and especially if every little exposure to cold aggravates the existing conditions. We will mention a few of the many more without attempting to classify them, such as Alumina, Ambra gris., Amm. mur., Iodine, Kali carb., Phosphorus, Phos. acid., Sepia, Lachesis, Spongia, Drosera, Eupat. perf., Balsam peru., Calc. sulph., Grindelia, Gummi am., Kreosot., Myosotis, Scilla, Senega, Yerba santa, etc., and refer for indications first to the articles on cough and tuberculosis, then to the repertory and the materia medica, last and best of all the game. PAGE 34 So far as adjuvants are concerned I have not found medicated inhalations of any advantage, especially when the homoeopathic medication was skilfully applied. Avoiding exposure to cold or damp air, and warm, woollen-clothing, dry air and sunshine are all that is necessary. Flax seed emulsion with raisins and lemon juice to flavor is not medicinal, and is soothing to the irritated membranes, an nutritious. It may be used freely and often is very grateful to the patient. It also has a good moral effect and makes the patient feel that he is doing more than when taking only the little pills or watery solution. PAGE 35 Asthma In giving indications for the remedies for this distressing complaint we have in mind more particularly the variety called Bronchial Asthma, or the true asthma which is a pure neurosis, though those varieties which are termed by various authors as cardiac, hay, renal, thymic, etc., will come, according to symptomatic indications, within the scope of the same therapeutic agents, for, as Raue said in regard to organic heart troubles, the symptoms indicating the curative remedy may often lie outside those which go to make up the pathology of the case. This is a great advantage to the prescriber and does not limit him to understanding the exact pathological condition before he can prescribe. We are often able by such symptom covering to cure cases upon which the best pathologists would differ as regards exact conditions. There is perhaps no disease upon which there has been more speculation and less understanding as to its true cause, nature and so forth than this Asthma now under consideration. It is also as difficult to cure. But we have remedies that do often alleviate and sometimes cure, and they are as follows : Ipecac. Spasmodic form of asthma, violent contraction, with rattling or wheezing in the bronchial tubes, seems as if would suffocate form constriction, agg. on motion, and often accompanied with nausea or vomiting. Arsenicum has just as severe oppression of breathing, is much agg. at night, especially 1 to 3 a.m. Also on lying down, must sit up for fear of suffocation. It is also great agg. on the least motion, particularly on ascending, and is amel. by warmth or warm air, or room. There is often great anguish, restlessness and thirst for small quantities of water at a time. PAGE 36 These have been the two great remedies from way back. I used to alternate them, and often with marked relief, but think it is better to give the Ipecac first and hold the Arsenicum in reserve to follow if necessary, if indicated of course. Natrum sulphuricum has served me well in a number of cases, when the paroxysms were agg. or brought on by damp weather which is often the case. Here there is also great rattling and wheezing, and the chest hurts as badly as in the dry cough of Bryonia. The patient holds the chest with the hands, it hurts him so to cough. This remedy is oftenest useful in the chronic form, I generally give it in the 30th. Senega has relieved, and for a long time, some of the worst cases I ever saw. See my Leaders in Homoeopathic Therapeutics for a fuller description. It must be given low, 3 to 7 drops of the tincture in half glass of water and dessertspoonful dose at intervals corresponding with the violence of the case. I do not know of any work or practice that mentions it for this affection. Now besides these there are many remedies that have done good work. I might mention a few of them, such as Lobelia which, in addition to the usual difficult breathing, has a marked sense of emptiness in the stomach, and a sensation of a lump pressing up into the throat. Dulcamara may be the remedy when there is much accumulation of mucus, and, like Natrum sulph., is agg. or brought on by damp cold weather. Aralia racemosa with the general asthmatic symptoms is very prone to come on after the first sleep. Kali carbonica has done beautiful work, especially in elderly people, where the patient had to sit bent forward to breathe, and the cough was decidedly agg. at 3 a.m. Anaemia with bag-like swelling of upper eyelids is strongly corroborative. PAGE 37 Antimon. tartaricum is often beneficial in the cases that become very loose and rattling, coarse rattling, with inability to expectorate; marked relief follows expectoration. Lachesis. Attack comes on after sleep and cannot bear anything around throat or chest, Especially in cardiac cases. To go through all the remedies that might become useful in this disease would be to rehearse all that is given in Raue, Lilienthal and other works on practice. We must refer you to them, and again to the repertories and materia medica. So far as auxiliaries are concerned there are many of them, such as the different preparations of Stramonium, Nitrate of potash, Chloroform, Amyl nit., etc., but the best of all is a change of location generally to higher altitude and equable climate. If there is any disease in which a resort to these temporary relief measures would be justifiable it would be in this. I will say in closing that I have succeeded in a few cases in giving complete relief by a long course of treatment along antipsoric lines, but not always then. But the greatest hindrance here is that the patients will not consent to a long continued course of treatment; often because they cannot afford it. So far as those two conditions of diseases, which occur in connection with, or as a consequence of, Bronchitis or Broncho-pneumonia, and called Bronchiectasis or Emphysema, either interstitial or vesicular, the indications for the remedies are the same, or so nearly so that it would not be possible to draw very strong lines of distinction. When the case comes to that in any great degree, there is not much hope for a perfect cure, but there is under homoeopathic treatment often greater relief and comfort for the patient than under any other. PAGE 38 PAGE 39 Pertussis (whooping cough) This affection, now classed among the infectious diseases, is to be treated homoeopathically just as it was before the Bacillus pertussis eppendorf was discovered. In the first stage, when it can hardly be distinguished from a common cold, Belladonna, is as often indicated as any other remedy. Of course, other remedies may supersede it according to indications. After the whooping stage begins, if there is considerable wheezing and spasmodic coughing with blueness of the face during the paroxysm, also gagging and vomiting, Ipecac comes in. If, instead of becoming loose and wheezing, it continues dry and hard, and hurts the head and stomach or abdomen, is agg; in the morning or after eating. Nux vomica is better. Belladonna and Nux vomica given early in the case will sometimes so modify it as to need very little medicine afterwards. If the case does not come to us until after the whooping stage is already on, there are a large number of remedies which will have to be chosen from. If the case is in a young child, the cough is violent and the child becomes stiff during the paroxysm, it chokes and swallows as if trying to swallow something down; it looks pale with pale streaks around mouth and nose, rubs its nose, urine profuse or milky after standing awhile, we have a case for Cina, which will often do wonders. With Drosera the paroxysms are very violent, drawing the whole abdomen spasmodically inward, vomiting of food or mucus, and bleeding from the nose, and sometimes the mouth. Cuprum metallicum is adapted to one of the worst forms of the disease. The paroxysms are very violent and long continued, completely prostrating the patient. The child becomes rigid, turns blue or black in the face, lies as if dead. There is sometimes vomiting after the attack, and rattling of mucus between. It will do best as high as the 200th potency. PAGE 40 Corallium rub. also has a cough so violent that the child turns purple or black in the face. With Coccus cacti there is expectoration of large quantities of viscid, stringy or albuminous mucus at the end of each spell of coughing. Arnica. The child cries before each paroxysm because of the soreness. It hurts him so to cough. Kali bichrom. should be remembered in these cases which, like Coccus cacti, has a large amount of stringy mucus expelled. It hangs down in a long string. Veratrum album is one of the chief remedies in the convulsive stage. The child coughs itself into a regular collapse, falls over exhausted with cold sweat, especially on the forehead. It follows well after Cuprum met. in these mots violent cases. After this stage is modified or past, the stage of looseness or rattling of mucus follows, and may need such remedies as Pulsatilla if the expectoration is thick, green and the patient craves fresh, cool air, and is amel. in a cool room. Antimon. tart. if there is much rattling (coarse rattling) of mucus which is difficult to expectorate, especially if the child gets cyanosed from the abundant accumulation. When the child coughs, it seems as if a cup full of mucus would come, but it does not. Sleepiness or coma results. Expectoration relieves. Carbo veg. may follow it if the weakness and general blueness from unoxygenized blood, with great hunger for oxygen, wants to be fanned hard to breathe, coldness and prostration. PAGE 41 Kali sulph. is useful in those cases in which, after the case is well along, there remains a persistent rattling of mucus, which reminds one of Pulsatilla, but it does not finish up the case. Sulphur is of course never to be forgotten in any stage, especially in psoric complication, and also in this convalescent stage which we wish to prevent running into a chronic condition leading to permanent lung trouble. For indications see Cough and Tuberculosis. If the case goes on to a pronounced Bronchitis, Pneumonia or Broncho-pneumonia, the sections on those diseases must be consulted. The above are the main remedies; there are many others that may come in, in fact, do. I will here incorporate with some modifications from Jahr. If the paroxysm is preceded by spasm of the glottis, Ipec., if preceded by anxiety, Cuprum; if by weeping and moaning, Arn.; if attended by hemorrhage from the mouth or nose, Dros., Cina, Ipec.; if vomiting of mucus without food, Dros., Verat. alb., Ipec., Tart. em.; with vomiting of the ingesta, Dros., Ipec., Bryon.; Involuntary discahrge of urine, Caust., Squill., Verat. alb.; pain in the pit of stomach, Bry., Nux., Dros., pain in the abdomen, Nux v.; paroxysms of suffocation, Ipec., Cupr., Coral., Verat. alb., Arsen.; pains in the chest, Bry., Phos., Caust.; convulsions of the extremities, Cup.; tetanic spasms, Cina, Cup., Ipec.; if the attacks end with nose bleed, Cina, Indigo; with Sneezing, Cina, Bell.; with vomiting, Cina, Ipec., Cuprum; with gurgling down into the abdomen, Cina; with long continued sspension of breathing, Coral., Cuprum; with weeping or moaning, Cina, Arnica; with great lassitude or weakness, Verat. alb., Arsen.; if between the attacks there is rush of blood to the head, Bell., Bry.; sore thraot with pain, Carbo veg., Bell.; vomiting, also without cough, Ipec., Puls., Tart. em., Verat. alb.; a good deal of mucus in the air passages, Cup., Ipec., Cina, Tart. em., Seneg.; slow fever, with indolence, weakness, weariness, chilliness, thirst, Verat. alb., Arsenic.; miliaria, especially, Ipec., Carb. v., Verat. alb.; bloated face, especially over the eyes, Kali c.; finally if the paroxysms of cough set in principally in the evening or at night, Dros., Puls., Carb. veg.; early in the morning of after midnight, Kali carb., Hepar, Dros.; early in the morning and forenoon, Nux vom.; after a meal, Nux v., Ipec., Bry.; while eating, Calc., Ferr.; worse in the open air, Carb. v., Rumex, Phos.; worse coming into a warm room from open air, Bry., Nat. c. For other indications see repertory and articles on Cough and Tuberculosis. PAGE 42 The flax seed emulsion is also, as directed under Bronchitis, a good thing, and does not interfere with the most delicate homoeopathic remedies. PAGE 43 Pneumonia However desirable it might be to state exactly whether we had what the text books classify as croupous or lobar, or catarrhal or lobular pneumonia, or whether the micro-organisms, pneumococcus, or streptococcus were present (for in 103 cases of broncho-pneumonia examined by Netter, Weichselbaum and Pierce the streptococcus was found in about 30 and the pneumococcus in 29) for diagnostic purposes, it is not so necessary for therapeutic purposes. And, when we remember that a typical case of lobar pneumonia, as compared with the complicated forms of Broncho-pneumonia, Pleuro-pneumonia, etc., is comparatively rare, we are confirmed in the conclusion that not much success would be likely to follow routine prescribing. Whether the disease (so-called) begins in the lobe and extends upward or outward or whether it begins in the bronchi and extends downward and outward to the pleura and adjacent organs, is not of so much account as the being able to recognize those symptoms that are peculiar and characteristic in each individual patient, and to choose the homoeopathic remedy that most nearly corresponds, in its pathogenesis, with those peculiarities. Bryonia, Phosphorus or Sulphur may be the remedy in either case, and must be chosen largely from indications outside these diagnostic points. Similia Similibus is the guide, no matter in what form or stage of this or any other disease. The remedies most apt to be indicated in the first, or stage of engorgement, of pneumonia, are Aconite, Belladonna, Ferrum phos. and Veratrum viride. PAGE 44 Aconite, if there is a history of chill in cold dry air. The chill is generally pronounced and is promptly followed by high grade inflammatory fever, great heat, dry skin, intense thirst, restlessness, fear and anguish, patient tosses about in agony with loud complaints. The expectoration with the cough is tenacious and lumpy, of dark cherry red color. Now if Aconite is exhibited in potency from the 6th to the 30th, oft repeated, there will generally follow profuse perspiration and amelioration of all the other symptoms. But if such is not the case after twenty-four hours Sulphur 30th once in 2 hours will complement and often conquer the disease in its first stage. These two remedies will abort many cases, if we are called to a case of this character in time, as I can affirm from experience. Belladonna is to be preferred in this stage, if the fever and heat is fully as great as that of the Aconite case, but the patient is more stupid, not so anguished, but jerks and twitches in sleep, is delirious, the eyes are very red, the face dark red and bloated, especially upper lip; the carotids throb and beat visibly, and instead of the universally hot, dry skin there is sweat on the covered parts; the blood ?.to mount to the brain as well as the chest, and it is sometimes, especially in children, difficult to tell whether the brain or lung is the center of the trouble, from outward signs. The Belladonna case is more apt to run into that condition which is called typhoid pneumonia. Ferrum phos. seems to me to stand midway between Aconite and Belladonna, for while it does not present the excitement and fear of Aconite, on the other hand it does not produce so strong brain symptoms as Belladonna. I have found it of most service in pale anaemic subjects, who are subject to flushes of heat and redness of the face, and to local congestions generally. It certainly does fine work in such subjects in this stage of the disease. In regard to PAGE 45 Verat. viride I wrote in Leaders that at one time it had a great reputation in the first or congestive stage of inflammatory diseases, and especially in those organs coming under control of the pneumo-gastric nerve, viz., pharynx, oesophagus, stomach and heart. For a time the journals fairly bristled with reported cures of pneumonia, and its curative power was attributed to the influence of the remedy to control the action of heart and pulse. It was claimed that if we could control the quickened circulation so as to decrease the amount of blood forced into the congested lung, that you thereby gave the lung a chance to free itself of the existing engorgement. It looked plausible, and certainly in many cases remarkable cure were effected, and that in a short time. I was a young physician and thought I had found a prize in this remedy. But one day I left a patient, apparently relived by it of an acute attack of pneumonia, to go to a town five miles distant, and when I returned found my patient dead. Then I watched others so treated, and found every little while a patient with pneumonia dropping out suddenly when they were reported better. Now we dont hear so much of Veratrum viride as the greatest remedy for the first stage of this disease. What was the matter? 1st. It was (like other fads) used too indiscriminately. 2d. It is not desirable (it is wrong) to control or depress the pulse regardless of all the other conditions. 3d. The patients who had weak hearts ere killed by this powerful heart depressant. A quickened circulation is salutary in all inflammatory diseases, and is evidenced that the natural power to resist disease, is there and at work. The pulse will come to its normality when the cause of its disturbance is removed and should never be forced to do so until then. Here is a common fault of the old school, notwithstanding their cry of Tolle causam. So I find fault with Guernseys keynote, Great activity of the arterial system; very quick pulse. Next to Digitalis. Veratrum viride slows the pulse, as is abundantly shown in the provings. If quick pulse is ever the result of this remedy, it is a secondary or re-actionary effect, like the sleeplessness of Opium or the constipation of cathartics. So it seems to me that as an antiphlogistic (forgive me) it must go into the shade with the vaunted Digitalis. PAGE 46 Gatchel writes (pocket book) : This is the most important remedy in the stage of engorgement, to which its use must be limited. In my own experience and in that of others, it has apparently cut short oncoming attacks of pneumonia. It must be given early, immediately following the chill. It is of no avail after hepatization has begun. Again, if it produces nausea, reduce the dose. Watch the action to avoid cardiac depression. I should object to the wholesale assertion that this is the most important remedy, for the most important remedy is the homoeopathically indicated one, and it is not Verat. viride always by any means. I fully concur with him in the necessity of watching its action and for the same reason. I do know of one good characteristic indication for its use, not only in congestion of the lungs, but in other congestions also, viz., the well defined red streak running right through the middle of the tongue. It has been repeatedly verified. So while it is true that it may be able to cut short oncoming cases of this disease, I should be sure one of the other more safe remedies was not indicated before I would use it, especially in weak heart cases. PAGE 47 In the second stage, that of hepatization, we have quite a long list of remedies. Prominent among them are Bryonia, Phosphorus, Iodine, Rhus tox., Hyoscyamus, Lachesis, Sanguinaria, Mercury, Chelidon., Ant. tart., Lycopod., Opium, Kali carb., Carbo veg., Arsenicum, Sulphur, Calcarea carb. and others. We say others because this list must be added to in peculiar cases and the whole materia medica must be the resort of the homoeopathic physician in all cases, and the name of the disease has little to do with the selection. Bryonia is very often indicated after the remedies for the stage of engorgement have done all they can. It is especially in cases of pleuro-pneumonia that it is most useful. The fever still continues being only partially controlled by the former treatment, the breathing is short, expiration shorter than inspiration, the patient wants to lie perfectly still on the painful side, as the least motion aggravates all the symptoms; there is great thirst for large draughts of water, with corresponding dryness of mouth, and lips, which are dry and cracked, or parched (only exceptionally there is no thirst), the expectoration is generally tenacious and sometimes falls in round jelly-like lumps of a yellow or soft brick shade. It is the stage of exudation, or the second stage of the inflammatory process, and if given in nick of time, in not too low a potency, say, 12th to 200th, will often finish the case, promoting absorption and all. If it does not complete the case, but has well started it toward cure, no remedy follows it so well (generally) as Sulphur, which will often do the rest and prevent chronic conditions following. The pains of Bryonia are characteristically stitching pains, which, occurring as they do in serous membranes, show that the pleura is involved. PAGE 48 Phosphorus is very different. There is greater oppression of the chest, feels as if there were a load pressing it down. The parenchyma of the lung is the center of action and the pleura not so much involved, if at all; the expectoration is often profuse, and when falling on paper, on a hard surface, will break and fly like batter; the temperature is very high with circumscribed red cheeks (Sang.), cough hurts and makes him tremble and is worse lying on the left side; the patient moans or grunts with every breath, and suppresses the cough by it, juts as long as he can because it hurts him so. Phosphorus attacks by preference the lower right lung or lobe. It may be indicated by the symptoms at the beginning of the stage of hepatization, when it puts a stop to the further progress of the disease, but its more brilliant effect is when the stage of hepatization is completed and we want to break it up and promote resolution. Here it has no equal. Under its action the hitherto restless patient will, (in the 30th, 200th or 1000th potency), sink into a sweet sleep, profuse perspiration will set in, and with the waking we are in full tide of convalescence, the expectoration becomes free and easy, the mind tranquil, and, in short, all the violence of the storm is past. A dose of Sulphur or Lycopodium may be needed to finish the case, and will be given according to indications, of course. We will next mention. Iodine. Kafka says at the beginning when the diseases localizes itself. Well, if that was all, what a dead easy time we would have of it. Gatchel does better than that when he says It replaces Bryonia in a certain class of subjects. There is fever with high temperature, but an absence of the pleuritic pains of Bryonia. The class of subjects is a large factor in the Iodine case. It is the subject that is spare, dark complexioned (brunette), dark eyes, subject to scrofulous affections of the glands, especially goitre. The fever does not give way to Aconite, but continues with great general nervous and irritated manifestations, even when the case has gone on to a chronic form. Absorption does not take place, and the patient emaciates greatly, though he may want to eat and feels better while doing so. In such cases Iodine may do more than any other remedy. My observation is that it does better low, say, the 2d trit., than higher. Lycopod. follows well and is adapted to the same kind of temperament. PAGE 49 Rhus toxicod. If the case assumes a typhoid tendency, as shown by the tongue with its dryness and triangular red tip, and the excessive restlessness which keeps the patient tossing about, and the sensorium is blunted with low delirium. If this remedy does not, within a reasonable time, modify the symptoms and the delirium increases, also the stupor until the case if unconscious, no remedy surpasses Hyoscyamus. I am quite sure this remedy (Hyos.) is not so well and favorably known as it should be in this disease. Lachesis, if the Rhus and Hyos. fail, will do good work if the stupor increases, the weakness also; the patient is unable to put out the tongue, it trembles and catches behind the lower teeth when trying to protrude it, showing great weakness, there is great oppression of breathing with aversion to having anything touch the chest or throat, pulse weak and intermittent, with general aggravation of the whole case after sleep. Left-sided pneumonia oftenest calls for this remedy. Opium is sometimes of great use in old topers, where there is sopor with heavy breathing, even stertorous; the whole body bathed in a hot sweat, and the patient complains of the bed feeling too hot. PAGE 50 Sanguinaria. Typhoid pneumonia, second and third stage, extreme dyspnoea, tough, rust colored sputa, face and hands cold, or the opposite hot and burning (Sulph.), circumscribed redness and burning heat of the cheeks, especially in the afternoon. Arsenicum and Carbo veg. are both indicated in those desperate cases that resist the above remedies. Arsenicum is most likely to come in after Rhus tox. If there restlessness continues and added to it the weakness and prostration increases. There is great thirst for small quantities at a time, burning pain and heat in chest (Sang.), feels better from warmth and is worse from 1 to 3 a.m. generally. Carbo veg. Cough by spells or no cough; if cough with rattling but too weak to expectorate (Ant. tart.); Ant. tart. has ?ailed; hippocratic face, nose pinched and cold; lips, hands, feet and skin blue and cold, breath cold, dyspnoea great, wants to be fanned, cant get oxygen enough, vital force almost expended. I have seen several such cases come out under Carbo veg., re-action setting in so that other remedies that did not act satisfactory will now take hold and do better work. Antimon. tart. is often of great utility where the case has gone into what might be called the loosening up stage. The chest seems full of mucus with coarse rattling and cough which seems as though it must bring up large quantities, but it does not; the patient becomes cyanotic from want of oxygen, which the great accumulation of mucus shuts out, there seems to be lack of strength to expectorate, even threatened paralysis of the lungs; fits of suffocation. This is the condition that precedes the desperate stage of Carbo veg. and may save the patient from it. It is oftenest found in children and very old people. PAGE 51 Ipecac., which also has great accumulation of mucus, is again useful in children, but the oppression of breathing is accompanied with squeaky wheezing breathing instead of the course rattling of Ant. tart. Mercurius, Chelidonium and Kali carb. are a trio that go well in company. These remedies all suit cases of pneumonia with bilious complication. Mercurius, if there are with the oppressed breathing stitches in right chest through from scapulae; cough, first dry, afterward attended with bloody expectoration, great tenderness in region of stomach, and, especially, liver; mouth and tongue moist, but tongue large, flabby, showing imprint of the teeth, great thirst and profuse sweat without relief, worse at night and when lying on right side. Kali carbon. also has stitching pains running through lower part of right side, and the cough is worse toward 3 a.m. , there is wheezing and rattling breathing, pulse often intermitting. It is often a complementary to Bryonia when that remedy has only partially relieved the stitching pains. Of course Mercurius and Kali carb. cases are oftener the ones in which bilious or pleuritic complications are markedly present. Chelidonium has pain under the right shoulder-blade and in the liver, with marked jaundice, yellow face and skin, tongue coated yellow at the base (Merc. prot), yellow urine and very yellow stool, yellow as gold, or very white stools. All these remedies have done good work in such cases, and have done it both in low and high potencies. For the use of Kali iodatum see my Leaders in Homoeopathic Therapeutics, page 118, third edition. I will not repeat that here as I have not had occasion to use the remedy in pneumonia, though others have and with beautiful results; PAGE 52 Now when we come to the third stage, the stage of gray hepatization, which follows that of red hepatization, when the acute inflammation in the lung has passed by, and nature begins the task of clearing away the products of the disease, which is accomplished by the cells, which have been extravasated, undergoing fatty degeneration and granular change, while the fibrin undergoes softening. During this stage of resolution the exudation is gotten rid of by absorption and expectoration. Finally the air cells are freed from the exudate which has been filling them, the epithelium lining them is reproduced, and recovery results. (Hare). To hasten this most desirable result, or to secure it when nature in her unaided efforts is unable to accomplish it, we have another class of remedies, among which may be mentioned Sulphur, Calcarea, Lycopod., Hepar, Sanguinaria, Psorinum, Tuberculinum and others. Sulphur has always, and perhaps always will, occupy first place here, as indeed it does in many other diseases where the process of absorbing the effusions which are the result of acute or even chronic inflammation is desired. It is especially useful if after the violence of the storm of active inflammation is passed there remain fitful flashes of fever ending in debilitating sweats, faintness or weakness. These are the cases which do not finish up their stages well, and it is generally on account of psoric taint in the patient. Hence relapses occur again and again on account of deficient vital reaction. Se have not only the disease to deal wit, but a condition of the patient which existed before-hand, perhaps all his life. Such patients will have Sulphur symptoms in general. The case will not clear up, the apparently indicated remedy does not act satisfactorily. It may be a Sulphur subject, viz., - lean, stoop-shouldered persons, who walk or sit stooped, standing especially aggravates. Skin eruptions are present, or were in his usual condition, but especially if they have disappeared during the progress of the diseases. If this latter is the case, probably a restoration of the skin eruption will be necessary before there will be satisfactory improvement or cure. PAGE 53 Burning in chest, skin or locally in many places, and especially of the feet, which must be stuck out of bed to cool them. Weakness, or weak, empty or gone feeling at the stomach, especially worse at 11 a.m. ; white tongue with very red tip and borders, bright redness of the lips as if the blood would burst through, or redness of any and all orifices. All or any of these symptoms present will point to this great antipsoric, and when we remember its strong powers of absorption, we may then readily understand why Sulphur leads the van in the list as a finisher of the case. Calcarea carb. stands for a different class of subjects, viz., the leucophlegmatic. Fair, fat and flabby. There is characteristically coldness instead of burnings. I cannot do better here for want of space than again to refer you to my Leaders in Hom. Therap., 3d Ed., page 60, to get the picture. The case continues to cough and expectorate, agg. in the morning; the external chest becomes sensitive to touch and sore. Sensation in feet and legs as if she had on cold, damp stockings; night sweats, general, and especially local sweats, to which the patient may have been subject all her life. She was sweaty headed as a child. Now Calcarea may save this case from running on to consumption if it is given properly. PAGE 54 Lycopodium is one of the best remedies for the later stages of typhoid or neglected pneumonia, and is especially indicated when there is copious expectoration, the parenchyma of the lung sounds full of mucus, there is often circumscribed redness of the cheeks, especially at 4 to 8 p.m. ; often red sand in the urine and fanlike motion of the alae nasi. It is often the best remedy to finish the cure where there have been liver complications such as we noticed under Mercurius, Chelidon. and Kali carb. Of course, if we have the flatulent condition so characteristic of this remedy it is additional indication for its use. In the use of these remedies (Sulph., Calc. and Lyc.) I never use at this stage anything below the 30th potency, and often use much higher. Sulph. 55m, Fincke, and Lycopod. 6m., Jenichen, are favorites with me. Sanguinaria is often of greatest utility when the profuse expectoration becomes very offensive to the patient. It also has circumscribed redness of the cheeks, and acts especially well on the right upper lung. I have used the 200th with good results, but have also seen the most prompt and radical results from the 2d trituration of the alkaloid. Psorinum has profuse green expectoration and the patient is very despondent, thinks he is never going to get well, and sweats from weakness on the least exertion or when asleep. Tuberculinum is useful in patients of tubercular history, when the patient complains of feeling as if he had taken a new cold on the least exposure, and it has erratic pains like Pulsatilla, appearing now here, now there, in different parts of the body. Pulsatilla will sometimes close up the case when the expectoration becomes thick, profuse, green and bitter or offensive tasting, and the patient feels chilly, yet cannot bear the atmosphere of a close warm room. PAGE 55 Kali sulph. where the expectoration is like that of Pulsatilla, and the aggravations and ameliorations are similar. It seems to be what we call the chronic of Pulsatilla. Hepar sulphur. often helps where there remains a wheezy condition, and the least cold air makes the cough worse. This combination of Lime and Sulphur is wonderful, and while it has symptoms similar to each, has new ones of its own. It is a remedy well worth bearing in mind in these cases. Now in regard to auxiliary measures. In regard to stimulants so much vaunted now-a-days by many, the best stimulant is the homoeopathic remedy. Hare (old school) says; It is, however, a fatal mistake to think that every patient suffering from this disease should be stimulated. He recommends in some cases Aromatic spirits of Ammonia, and Hoffmans Anodyne. And here is something for those quasi-homoeopaths who are so anxious and fearful that the homoeopathic remedy will not do all that is possible. The same old school authority says At the present time it has become fashionable for physicians (of the old school, of course) to adminis